Insurance Denial Claim FAQs

Was your insurance claim denied, delayed, terminated or underpaid in British Columbia? The denial letter is important, but it is not necessarily the final word. The policy wording, application, medical or technical evidence, claims record and applicable deadlines all matter.

These answers cover frequently asked questions relating to long-term disability, life insurance, critical illness, accidental death and dismemberment, mortgage protection, home and commercial property loss, fire, water damage, business interruption and insurance broker negligence. Taylor & Blair LLP acts for policyholders and beneficiaries, never for insurance companies, throughout all of British Columbia.

Every claim is fact-specific. This information is general and is not intended to be legal advice. If a deadline may be approaching, obtain legal advice promptly.

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What Should I Do After an Insurance Claim Is Denied?

Save the denial letter, complete policy, application, endorsements and all claim correspondence.
Ask the insurer to identify the precise policy wording, facts and evidence relied on.
Do not sign a release, accept a “full and final” payment or submit a detailed appeal before understanding the consequences.
Preserve evidence. For property claims, photograph the loss, retain damaged items where safe and keep estimates, invoices and receipts. For disability claims, continue appropriate medical care and document how your condition affects function.
Record every deadline in the policy, denial letter and legislation. Do not assume an internal appeal or complaint pauses a legal limitation period.
Speak with an insurance denial lawyer early enough to preserve your options.

Related guide: Tips for dealing with your insurance company

Insurance Claim Denial FAQs: Table of Contents

Still Have Questions About a Denied Insurance Claim?

Taylor & Blair LLP represents policyholders, beneficiaries, homeowners and businesses across British Columbia in denied, delayed, terminated and underpaid insurance claims. We do not act for insurance companies. Contact us for a free consultation about your denial letter, policy and next steps.

Schedule your free consultation with an experienced insurance denial lawyer today.

Denied, Delayed & Underpaid Insurance Claims

Can an insurance company deny my claim?

Yes. An insurer may deny a claim if it concludes that the loss is outside the policy’s coverage, an exclusion applies, a condition was not met, required proof is missing, or material information was misrepresented or not disclosed. The insurer’s conclusion can be challenged. Coverage depends on the complete contract, the facts, the evidence and the law, not simply the label used in the denial letter. Understanding the specific policy is important, including the types of policies and insurers we deal with when reviewing denied claims.

Is a denial letter the final decision?

Not necessarily. A denial letter states the insurer’s position at that time. Depending on the claim, the next step may be to request the claim file and reasons, provide targeted evidence, use an internal or external complaint process, negotiate, mediate or begin legal proceedings. The right response depends on the policy, the reason given and the deadlines. If you are unsure what to do after receiving a denial, our insurance denial lawyers can review your claim and the options available.

What if my claim was delayed or underpaid rather than denied?

A claim can be disputed even when the insurer has not issued a complete denial. Unexplained delay, a partial payment, a low valuation, a narrow repair scope, termination of ongoing benefits or refusal to pay one component of a loss may all require review. Ask the insurer to confirm in writing what it accepts, what it disputes and why. Similar issues commonly arise in disputed and denied property loss claims, where the amount or scope of coverage may be contested.

Who decides whether my claim is covered?

The insurer makes the initial coverage decision through its claims personnel, adjusters and advisers. That decision is not binding simply because the insurer made it. A court or agreed dispute-resolution process may ultimately determine coverage, while valuation disputes may sometimes follow a separate process. An insurer’s initial decision can be challenged, and there are several ways we help clients dispute denied insurance claims

Should I speak with the insurance adjuster?

You generally must cooperate with reasonable claim investigation requirements, but you should communicate carefully and accurately. Ask for important requests in writing, keep notes, do not speculate, and correct material misunderstandings promptly. Before a recorded statement, examination under oath, medical examination or broad authorization, consider obtaining legal advice. Following practical tips for dealing with your insurance company can help you communicate carefully while your claim is being investigated.

What documents should I collect?

Start with the complete policy, declarations, endorsements, application, renewal records, denial or reservation-of-rights letter, claim forms, correspondence and payment history. Add evidence specific to the loss: medical and occupational records for disability; application and medical records for life or critical illness; and photographs, inventories, estimates, invoices and expert reports for property claims. Once you have gathered the available documentation, you can request a review of your insurance claim to better understand your options.

Should I appeal the denial myself?

Sometimes an internal appeal is useful, particularly when the insurer misunderstood a fact or genuinely new evidence can answer the stated concern. A generic appeal that simply repeats the original claim may add little and can lock in an incomplete record. Before appealing, understand the denial, the evidence needed, the appeal deadline and whether another legal deadline continues to run. If an appeal is appropriate, understanding how to write an effective LTD appeal letter can help you focus on the evidence and issues that matter.

Does an internal appeal stop the limitation period?

Do not assume so. A policy appeal, complaint or ongoing negotiation may not suspend the time for starting legal proceedings. Deadlines can arise from the policy, the Insurance Act, limitation legislation and procedural rules. Obtain advice about the deadline that applies to your particular claim. Some applicable deadlines and requirements may arise under the BC Insurance Act, although the deadline for a particular claim should be assessed individually.

What is insurance bad faith?

Insurers owe contractual duties and must handle claims in good faith. A wrong decision is not automatically bad faith. The issue may arise where claim handling is high-handed, unfair or without a proper basis, but the legal test and available remedies are fact-specific. Preserve the full communications record and obtain advice rather than assuming every delay or denial qualifies. Our discussion of bad faith in insurance denials explains when an insurer’s handling of a claim may raise additional legal issues.

Can I complain to an ombudservice?

Potentially. The General Insurance OmbudService addresses many home, auto and business insurance complaints, while the OmbudService for Life & Health Insurance addresses life and health matters. These processes are generally used after the insurer’s internal complaint steps and final position. They may not stop legal deadlines, and they are not a substitute for case-specific legal advice. For general insurance disputes, the General Insurance OmbudService process provides another potential avenue for addressing a complaint.

Long-Term & Short-Term Disability Insurance Claims

Why are disability claims denied or terminated?

Common reasons include alleged insufficient medical evidence, a conclusion that the policy’s definition of disability is not met, a pre-existing-condition exclusion, missed proof requirements, alleged non-compliance with treatment, surveillance or online activity, and the change from an “own occupation” to an “any occupation” test. Each reason should be tested against the actual policy and functional evidence. Understanding the common reasons long-term disability claims are denied can help identify the evidence and policy terms that need closer review.

What do “own occupation” and “any occupation” mean?

Many policies first ask whether illness or injury prevents you from performing the essential duties of your own occupation. After a stated period, the test may change to whether you can perform another occupation for which you are reasonably fitted by education, training or experience. Exact wording, including any income threshold, matters. The distinction between own occupation and any occupation disability coverage can significantly affect whether benefits continue.

Should I stop working before applying for disability benefits?

That is a medical, financial and legal decision, not a step to take solely for an insurance claim. Speak with your treating provider about safety and functional capacity, and review the policy’s waiting period and disability definition. If you attempt modified work, document the duties, hours, accommodations, symptoms and reason the attempt succeeds or fails. A long-term disability return-to-work program can also raise important questions about work attempts, accommodations and ongoing eligibility.

How often should I see my doctor while on disability?

Follow medically appropriate treatment and attend appointments at a frequency recommended by your providers. Insurers often look for current evidence, but appointments should have a clinical purpose. Ensure your providers understand your actual job demands and record functional restrictions, limitations, treatment response and prognosis, not only the diagnosis. Treating providers can play an important role in obtaining long-term disability benefits by documenting restrictions, limitations and treatment over time.

Can the insurer require questionnaires or medical authorizations?

Policies commonly require reasonable proof and ongoing information. Read each request carefully. Answers should be accurate, complete and consistent, while authorizations should be no broader than reasonably necessary. Keep copies. If a request is unusually broad, repetitive or unclear, ask for its purpose and consider legal advice before responding. questionnaires or medical authorizations? Our tips for dealing with your insurance company provide additional guidance on communicating and providing information during a disability claim.

Can the insurer conduct surveillance or review social media?

Insurers may use lawful surveillance and publicly available online information to test reported limitations. A brief observation rarely captures the full medical picture, but inconsistencies can be used against a claim. Be truthful, follow medical advice and avoid posts that lack context. Do not change ordinary, safe activity merely to create an impression. It is particularly important to understand how social media can affect a long-term disability claim and how online activity may be interpreted by an insurer.

Must I attend an insurer medical examination?

The policy may permit a reasonable medical or functional examination. Do not ignore the request. Ask who will examine you, the scope, the records provided and how the report will be used. Obtain legal advice if the request is disputed, overly broad or made near a termination or litigation deadline. Understanding the purpose of independent medical examinations in long-term disability claims can help you prepare for an insurer-requested assessment.

Can I travel while receiving disability benefits?

Travel is not automatically inconsistent with disability, but it can affect treatment, reporting obligations and how the insurer assesses function. Discuss the trip with your healthcare provider, follow policy requirements and be accurate about your activities. The ability to travel does not necessarily equal the ability to sustain full-time work, but context matters. Whether you can travel while receiving long-term disability benefits depends on your circumstances, policy obligations and how the trip relates to your reported limitations.

How does CPP disability affect my LTD claim?

Many LTD policies require an application for Canada Pension Plan disability benefits and allow the insurer to deduct CPP disability amounts from LTD payments. A retroactive CPP award can create an overpayment claim. Eligibility for CPP disability and entitlement under an LTD policy are different tests, although the evidence can overlap. There are important differences and overlaps between CPP disability and long-term disability claims, particularly where an insurer can offset CPP benefits.

Are disability benefits taxable?

It often depends on who paid the premiums and how the plan was structured. Benefits under an employer-paid plan are commonly taxable, while benefits under a plan funded entirely with after-tax employee premiums may be non-taxable. Confirm the premium history and obtain tax advice for your circumstances. The distinction between employer-paid and employee-paid disability insurance premiums can affect the tax treatment of benefits.

What if my union or employer has a disability plan?

The correct route may depend on whether the benefit is insured, self-funded or governed by a collective agreement. A grievance or arbitration process may apply, and an employer, union, administrator or insurer may hold different records. Obtain advice early so the correct procedure and deadlines are identified. The appropriate process can also depend on the particular policy and insurer involved in your disability claim.

Are professional and self-employed disability policies different?

They can be. Individual policies may contain occupation-specific definitions, residual or partial disability benefits, business-overhead coverage, future-increase options and non-cancellation features. Income records, billing data and the division between clinical, administrative and ownership duties can be central to the claim. Professional and self-employed disability claims can involve occupation-specific policy language and financial evidence that may not arise in standard group plans.

Life, Critical Illness, AD&D & Mortgage Insurance Claims

Why is a life insurance claim denied?

Common issues include alleged material misrepresentation or non-disclosure in the application, lapse for non-payment, an exclusion, a beneficiary dispute, questions about identity or cause of death, and a death during the policy’s contestability period. The application process, underwriting evidence, policy delivery, premium history and exact exclusion wording should all be reviewed. Reviewing the common reasons life insurance claims are denied can help identify which application, underwriting or policy issues require closer examination.

What is the contestability period?

Life policies commonly allow closer review of statements made in the application when death occurs within an initial period specified by the contract and legislation. A claim made later may still be disputed in limited circumstances, including alleged fraud. The timing alone does not decide the outcome; materiality, the questions asked and the evidence matter. period? A life insurance denial lawyer can review how the contestability period and the insurer’s stated reasons apply to a particular claim.

Can a life claim be denied for an error in the application?

Not every mistake automatically defeats coverage. The insurer may need to establish that a statement or omission was material under the governing policy and law, and different rules may apply depending on timing and allegations. Review the exact application question, the answer, the underwriting evidence and what the applicant reasonably understood. If an application error has resulted in a denial, you can have the denied life insurance claim reviewed before accepting the insurer’s conclusion.

What if there is a dispute over the beneficiary?

The insurer may delay payment or pay funds into court when competing beneficiaries make claims or the designation is unclear. Issues can involve the form of designation, later changes, estate claims, capacity, undue influence, family-law rights or policy ownership. Do not sign a release or distribution agreement without understanding the competing claims. Life insurance denial claims can involve beneficiary disputes as well as questions about coverage itself.

Why are critical illness claims denied?

Critical illness insurance pays only when the diagnosis satisfies the policy’s precise definition and other conditions. Denials may concern diagnostic criteria, specialist evidence, a survival period, an exclusion, a pre-existing condition, or alleged application misrepresentation. A serious diagnosis in everyday language may not match the insured definition, so medical evidence should address the actual wording. Understanding the common reasons critical illness insurance claims are denied can help identify whether the dispute concerns medical criteria, an exclusion or the original application.

Is critical illness insurance the same as disability insurance?

No. Disability insurance usually replaces income when illness or injury prevents work under the policy definition. Critical illness insurance generally pays a lump sum after a listed condition meets defined medical criteria. A person may qualify for one, both or neither. Each policy requires a separate analysis. Our information on critical illness insurance denials explains some of the distinct coverage issues that arise with these policies.

What is accidental death and dismemberment insurance?

AD&D insurance generally pays when death or a specified loss results from an accident as defined by the policy. Disputes often concern whether the event was accidental, whether illness contributed, timing and causation, and exclusions for drugs, alcohol, dangerous activities or other circumstances. The policy’s causal language is critical. AD&D insurance denial claims often turn on the policy’s definition of an accident and its requirements for causation.

Why is mortgage life or critical illness insurance denied?

Mortgage protection claims may be denied after post-claim underwriting, alleged application errors, eligibility disputes, exclusions or a conclusion that the diagnosis does not meet the definition. The lender is often the beneficiary to the extent of the mortgage debt. Review the enrollment process, disclosure questions, certificate, group policy and insurer’s reasons. Mortgage protection insurance denials can involve issues with enrollment, eligibility, underwriting and the policy’s definition of a covered condition.

Can the broker or person who sold the policy be responsible?

Possibly. A separate claim may arise if appropriate coverage was requested but not obtained, key exclusions or application questions were not properly explained, information was recorded incorrectly, or a warning was not given. The issue is what reasonable advice was required and whether proper advice would have resulted in coverage. In some circumstances, a denied claim may also raise a separate issue of insurance broker negligence.

Home, Condo, Tenant and Other Property-Loss Claims

What should I do immediately after property damage?

Protect people first, call emergency services where needed, and take reasonable steps to prevent further damage. Notify the insurer promptly, photograph and video the scene before major work where safe, keep damaged items unless disposal is necessary, and retain receipts. Do not authorize unnecessary demolition or permanent repairs before the loss is documented. Taking these early steps can also help preserve the evidence needed if the loss later becomes a denied property insurance claim.

Why are property insurance claims denied?

Common reasons include an exclusion, alleged wear and tear or gradual deterioration, vacancy or change in occupancy, late notice, failure to mitigate, insufficient proof, misrepresentation or non-disclosure, and disputes about the cause, scope or value of damage. The insurer should identify the specific wording and facts relied on. Our information on denied property loss claims explains the coverage and valuation disputes that can arise after damage to a home or other property.

What is a proof of loss?

A proof of loss is a formal statement giving required details about the loss and amount claimed. Property policies and legislation can impose deadlines and form requirements. Complete it carefully, attach available support, keep a copy and avoid guessing. If information is still being investigated, obtain advice about how to preserve the claim without making unsupported assertions. The BC Insurance Act contains requirements that may be relevant to proof of loss and other aspects of an insurance claim.

What does it mean to mitigate the damage?

Mitigation means taking reasonable steps to prevent avoidable additional loss, such as shutting off water, arranging emergency drying or securing an opening. It does not mean risking personal safety or agreeing that all emergency work is covered. Document why work was necessary, obtain written scopes where possible and keep damaged material when evidence may be disputed. Our tips for dealing with your insurance company provide further guidance on documenting a loss and communicating with the insurer.

Is water damage covered by home insurance?

Sometimes. Coverage often turns on the source and timing of the water, the applicable exclusion and any endorsement for sewer backup, overland water or another peril. A sudden escape from plumbing may be treated differently from seepage, groundwater, repeated leakage or deterioration. Causation evidence and the complete wording matter. Denied water damage insurance claims often require careful analysis of the source of the water, causation and applicable exclusions.

What if the insurer says the damage was gradual?

Ask the insurer to identify the physical evidence, expert opinion and policy clause supporting that conclusion. The visible damage may have developed over time even if the insured event was sudden, or multiple causes may be involved. Preserve plumbing components and building materials where feasible and consider independent technical evidence before permanent repairs erase the cause. Whether gradual damage exclusions apply is a common issue in denied water damage insurance claims.

Are sewer backup, flood and overland water the same?

No. Policies often define and cover these events differently, and separate endorsements, limits and deductibles may apply. Determine where the water entered, the sequence of events and whether more than one cause contributed. Do not accept a general “flood” label without comparing the facts to the policy definitions. These distinctions can be particularly important when assessing a denied water damage insurance claim.

What if mould is discovered after water damage?

Coverage may depend on whether mould resulted from a covered water event, whether remediation is necessary to complete insured repairs, and whether a mould, seepage or deterioration exclusion applies. Notify the insurer, address health and moisture concerns, preserve testing and remediation records, and distinguish the underlying cause from the resulting damage. Mould and resulting-damage issues may form part of a broader water damage insurance claim.

What does fire insurance usually cover?

Subject to the policy, a fire claim may include the building, smoke and water damage, debris removal, contents, code-related costs and additional living expenses. Disputes may concern cause, vacancy, alleged arson or misrepresentation, repair scope, depreciation, contents proof and replacement-cost conditions. Each component should be documented and assessed separately. Denied fire loss insurance claims can involve disputes about both coverage and the amount payable for different components of the loss.

What if the insurer alleges arson or misrepresentation after a fire?

Treat the allegation seriously and obtain legal advice before a recorded statement or examination under oath. Preserve documents, photographs, alarm and financial records, and do not speculate about cause. The insurer must assess the evidence and the applicable policy and legal requirements; suspicion alone should not replace a proper investigation. Allegations of arson or misrepresentation can significantly complicate a denied fire loss insurance claim and should be addressed carefully.

What are additional living expenses?

Additional living expense coverage may reimburse the reasonable increase in living costs when a covered loss makes the home unfit to live in, subject to policy wording, limits and time periods. Keep receipts and compare post-loss spending with normal expenses. Disputes often concern habitability, duration, family needs and whether rebuilding delays are reasonable. Additional living expenses are one of several forms of compensation that may be at issue in a property loss insurance claim.

What is the difference between actual cash value and replacement cost?

Actual cash value generally reflects depreciation, while replacement-cost coverage may allow further payment after repair or replacement conditions are met. Definitions and payment stages vary. Before accepting a settlement, confirm the valuation method, depreciation applied, deadlines to replace and treatment of taxes, code upgrades, matching and contractor overhead. Valuation disagreements involving actual cash value and replacement cost commonly arise in property loss insurance claims.

Can I choose my own contractor or expert?

Often you may obtain independent estimates or advice, although the policy and claims process may give the insurer inspection or repair rights. Ask whether a preferred contractor is mandatory or optional, and request that any guarantee be put in writing. For a major dispute, an independent engineer, hygienist, estimator, accountant or public adjuster may be helpful. Independent contractors and experts can be particularly important when the scope or value of a property loss claim is disputed.

What if my contents claim is underpaid?

Create a room-by-room inventory with photographs, receipts, model numbers, age and replacement links where available. Ask the insurer for its valuation sheet, depreciation and reason for rejecting items. Separate questions of ownership, existence, condition, replacement cost and policy limits. Do not inflate estimates; credibility is essential. Contents valuation is also a common issue in fire loss insurance claims involving significant damage to a home and personal property.

How do condo and strata insurance policies interact?

A loss may engage the strata corporation’s policy, the unit owner’s policy and potentially another person’s liability coverage. The strata bylaws, standard-unit description, deductibles, betterments and cause of loss can affect responsibility. Notify all potentially relevant insurers and preserve correspondence about which policy is expected to respond. Determining which policy responds can be an important part of resolving a condo or other property loss insurance claim.

What if the property was vacant or unoccupied?

Policies may distinguish “vacant” from “unoccupied” and may require notice or a permit after a specified period. The actual use of the property, utilities, furniture, renovation activity and intention to return can matter. Review the definition and endorsement rather than assuming the insurer’s label is decisive. Vacancy and occupancy disputes are among the issues that can lead to a denied property loss claim.

Can valuation disputes use an appraisal or statutory process?

Some property-loss amount disputes may be addressed through the dispute-resolution mechanism in the policy or BC Insurance Act. That process generally addresses the amount of loss, not every coverage question. Before invoking it, clarify what is admitted, what remains disputed, how the decision will interact with coverage, and the cost of experts. The BC Insurance Act sets out a statutory dispute-resolution process that may apply to certain disagreements over the amount of a loss.

Commercial Property & Business Interruption Insurance Claims

What should a business preserve after a property loss?

Preserve the policy, leases, photographs, damaged equipment, emergency invoices, repair schedules, sales records, budgets, payroll, inventory, purchase orders, tax returns and communications with customers and suppliers. Track mitigation decisions and extra expenses from day one. A contemporaneous loss chronology helps both coverage and financial analysis. Thorough documentation can be particularly important when dealing with a commercial property loss insurance claim.

What does business interruption insurance cover?

Business interruption insurance may cover lost business income and specified continuing or extra expenses resulting from an interruption caused by insured physical loss or damage. Coverage depends on the trigger, waiting period, indemnity period, calculation method, limits and extensions. It does not simply reimburse every revenue decline after an event. Denied business interruption insurance claims often involve detailed analysis of both the coverage trigger and the financial loss.

Why are business interruption claims denied or reduced?

Disputes commonly concern whether insured physical damage triggered coverage, how long operations should reasonably have been interrupted, projected revenue, saved expenses, trends unrelated to the loss, payroll, extra expense, supply-chain impacts and policy sublimits. Legal and accounting analysis should use the same factual timeline. Our information on denied business interruption claims explains the coverage and calculation issues that can affect payment.

How is lost business income calculated?

The policy formula usually compares the business’s expected results without the loss to actual post-loss results, then adjusts for continuing and saved expenses and relevant trends. Historical results are important but not always conclusive. Budgets, bookings, contracts, seasonality, market changes and mitigation can all affect the calculation. The calculation of lost income is often one of the central issues in a business interruption insurance claim.

What is an extra expense?

An extra expense is generally a reasonable additional cost incurred to avoid or reduce an insured business interruption, subject to the policy wording. Examples may include temporary premises, equipment rental, expedited shipping, data recovery or overtime. Obtain insurer approval where practical and document the expected loss avoided by each expenditure. Extra expenses may form an important component of a business interruption insurance claim when they help reduce the overall interruption.

What if the insurer and business disagree about the repair timeline?

The indemnity period may turn on how long repair or replacement should reasonably take, not simply the date the insurer makes its final payment. Permits, code requirements, design, procurement, contractor availability, owner decisions and uninsured upgrades can all affect the analysis. Maintain a critical-path timeline and record the cause of each delay. Repair timelines can affect both the property and income-loss components of a commercial property loss claim.

Can underinsurance or a coinsurance penalty be challenged?

Review the declarations, valuation basis, coinsurance clause, appraisal, renewal discussions and calculations. A policy may reduce payment when insured value falls below a required percentage, but the insurer’s inputs and application of the clause may be disputed. If appropriate limits were requested or recommended coverage was not obtained, broker advice may also require review. If the expected amount of coverage was not obtained, the circumstances may also raise questions about insurance broker negligence.

Insurance Broker Negligence Claims

When can an insurance broker be liable?

A broker may be liable where the broker failed to use reasonable care in obtaining requested or appropriate coverage, explaining a material limitation, communicating accurate information or advising about a known coverage need, and that failure caused a loss. The scope of the retainer, instructions, renewal history and available insurance market are important. Our information on insurance broker negligence claims explains how failures to obtain or advise about appropriate coverage may lead to a separate claim.

What evidence helps prove a broker-negligence claim?

Keep proposals, applications, emails, text messages, renewal summaries, certificates, invoices, notes of conversations and prior policies. Identify what coverage was requested, what the broker recommended, what information was provided and what would probably have happened with competent advice. The denied insurer claim and broker claim should be assessed together. These records can help establish the instructions and advice at the centre of an insurance broker negligence claim.

Should I sue the insurer, the broker or both?

That depends on whether the policy properly covers the loss and, if not, why the expected coverage was absent. The positions can be alternatives: the insurer may say the policy excludes the loss, while the broker may say the requested coverage was unavailable or not requested. Coordinated advice helps avoid inconsistent positions and missed deadlines. Understanding the distinction between an insurance agent and an insurance broker can also help clarify the role and responsibilities of the person who arranged the coverage.

Can a broker claim recover everything the policy would have paid?

The usual objective is to place the client in the position they would probably have occupied with reasonable advice, subject to proof of causation, available coverage, policy terms and other losses or defences. Damages are fact-specific and are not automatically equal to the amount claimed from the insurer. The potential recovery in an insurance broker negligence claim depends on what would likely have happened if reasonable advice had been provided.

Insurance Denial Lawyers, Settlements & Legal Process

When should I contact an insurance denial lawyer?

Seek advice promptly after a denial, termination, serious delay, low settlement offer, examination request, fraud or misrepresentation allegation, major property loss or uncertainty about a deadline. Early advice can focus evidence and preserve options. A consultation does not commit you to litigation. If you are facing a denial or another serious claim issue, you can contact our BC insurance denial lawyers to discuss your options.

What can a lawyer do about a denied claim?

A lawyer can review the contract and claim record, identify evidence gaps and deadlines, communicate with the insurer, obtain expert evidence, prepare a targeted appeal or demand, negotiate, mediate and, where appropriate, start legal proceedings. The strategy should be proportionate to the value, complexity and urgency of the dispute. Understanding what to expect when hiring an insurance lawyer can help you decide when legal assistance makes sense for your claim.

Will my case go to court?

Many disputes resolve through further investigation, negotiation, complaint processes or mediation. Some require a lawsuit to protect a deadline or obtain a binding result. Starting a claim does not mean a trial is inevitable. The best route depends on the legal issues, evidence, amount at stake and insurer’s response. Our guide to what to expect when hiring an insurance lawyer explains the different ways a denied claim may progress and potentially resolve.

What compensation may be available?

Depending on the policy and facts, a claim may seek unpaid benefits or covered loss, a declaration of coverage, interest and legal costs. In an appropriate case, additional damages may be claimed for breach of the duty of good faith, but such awards are not automatic. Settlement may also address future benefits, releases and tax consequences. The compensation available will depend in part on the particular type of insurance denial or coverage dispute involved.

Can disability claim settle for a lump sum?

Sometimes. A lump-sum settlement may exchange uncertain future payments for a negotiated present payment and release. Value depends on policy terms, benefit amount and duration, offsets, medical and vocational evidence, life expectancy where relevant, litigation risk, tax treatment and discounting. Independent legal and tax advice is important before signing. Understanding present-day value in long-term disability insurance claims can help explain how future benefits may factor into settlement discussions.

How much does an insurance denial lawyer cost?

Fee arrangements depend on the claim. Taylor & Blair LLP offers a free initial consultation and handles accepted insurance-denial matters on a contingency-fee basis, meaning legal fees are payable from a recovery rather than billed by the hour. The written retainer should explain the percentage, disbursements, taxes and what happens if there is no recovery. You can review our insurance denial legal fees and contingency-fee arrangements for more information about how accepted claims are handled.

What deadlines apply to an insurance dispute?

There is no safe one-size-fits-all answer. Notice, proof-of-loss, appeal, complaint and lawsuit deadlines may come from the policy, legislation, a collective agreement or court rules. The date of loss, denial, termination and discovery may matter differently. Obtain case-specific advice immediately and do not rely on ongoing discussions to protect time. The BC Insurance Act is one potential source of deadlines and procedural requirements, although the applicable time limit depends on the particular claim.

What Should I Do After an Insurance Claim Is Denied?

Insurance Claim Denial FAQs: Table of Contents

Denied, Delayed & Underpaid Insurance Claims

Long-Term & Short-Term Disability Insurance Claims

Life, Critical Illness, AD&D & Mortgage Insurance Claims

Home, Condo, Tenant and Other Property-Loss Claims

Commercial Property & Business Interruption Insurance Claims

Insurance Broker Negligence Claims

Insurance Denial Lawyers, Settlements & Legal Process

Still Have Questions About a Denied Insurance Claim?

Resources:

Areas of Expertise

Denied, Delayed & Underpaid Insurance Claims

Long-Term & Short-Term Disability Insurance Claims

Life, Critical Illness, AD&D & Mortgage Insurance Claims

Home, Condo, Tenant and Other Property-Loss Claims

Commercial Property & Business Interruption Insurance Claims

Insurance Broker Negligence Claims

Insurance Denial Lawyers, Settlements & Legal Process

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